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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844171
Report Date: 10/16/2024
Date Signed: 10/16/2024 11:23:49 AM

Document Has Been Signed on 10/16/2024 11:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RENU HOPE FOUNDATIONFACILITY NUMBER:
334844171
ADMINISTRATOR/
DIRECTOR:		DENISE DICKSONFACILITY TYPE:
850
ADDRESS:235 2ND STREETTELEPHONE:
(951) 845-3816
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY: 40TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
10/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Site Supervisor Denise DicksonTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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On the date and time listed, Licensing Program Analyst (LPA) Perla Ordones arrived at the facility to deliver the findings of a complaint investigation and a case management report. LPA was granted entrance into the facility by Site Supervisor Denise Dickson and explained the purpose of the visit. During the complaint investigation, LPA obtained information that an unreported unusual incident occurred at the facility during the month of August 2024.
 
LPA obtained information that stated that during August of 2024, that a staff member of the facility had fallen unconscious while in the Preschool 1 classroom. Pertinent parties confirmed the incident occurred and stated that children were present at the time. Additionally, pertinent parties stated that the staff member 
had to be escorted from the classroom with the aide of another staff member.
 
Based on the information obtained, the failure to report this unusual incident to the department is a violation of Title 22 regulation 101212(d)(1)(C) – Reporting Requirements.
 
See LIC809-D for cited deficiency. 
 
A notice of site visit was given and must remain posted for 30 days.
 
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
 
Exit interview conducted and report was reviewed with the Site Supervisor Denise Dickson.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/16/2024 11:23 AM - It Cannot Be Edited


Created By: Perla Ordones On 10/15/2024 at 05:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RENU HOPE FOUNDATION
FACILITY NUMBER: 334844171

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2024
Section Cited
CCR
101212(d)(1)(C)

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(d) Upon the occurrence... of any of the events specified in (d)(1) below, a report shall be made to the Department...
(C) Any unusual incident... that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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Licensee agrees to submit a written plan of action on how compliance will be maintained with the cited regulation. Licensee agrees to submit proof of the Plan of Correction (POC) to Community Care Licensing (CCL) by the end of the business day on the POC due date of 10/30/2024.
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Based on interview, the licensee did not comply with the section cited above as facility failed to report an unusual incident involving a staff member the site supervisor to the department which posed an potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Perla Ordones
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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